Understanding Clicking and Catching on the Inner (Medial) Side of the Knee

“Clicking” is a brief, audible or palpable snap inside the knee. “Catching” is when movement feels momentarily blocked or rough—sometimes with a need to wiggle or straighten the knee to “free” it.

On the medial (inner) side, the most common culprits are:

• Medial meniscus tears (including posterior horn/root tears)
• Medial plica syndrome (irritated synovial fold rubbing the femoral condyle)
• Pes anserine bursitis/tendinopathy (pain plus a rub or squeak, not true intra-articular catching)
• Snapping semimembranosus/MCL (tendon or ligament flicking over a bony edge)
• Loose bodies / osteochondral flaps (true locking; needs prompt evaluation)

Good news: many cases are mechanical but manageable with activity tweaks and targeted rehab. Your job is to separate benign clicks from problems that need imaging or procedures.

On the inner side, the medial meniscus cushions the joint; the MCL stabilizes it; the semimembranosus and gracilis/sartorius tendons insert just below the joint line at the pes anserine region; and a soft tissue fold called the medial plica can glide along the femoral condyle.

• Joint line tenderness + twisting pain → think meniscus.
• Tender spot 3-5{ cm} below the joint line → think pes anserine.
• Flange-like rub with squats/stairs, pain anteromedially → consider plica.
• True “stuck” knee that won’t bend/straighten → think loose body/meniscal flap → urgent exam.

• Typical story: twist or squat injury, or gradual onset with running/squats in mid-life.
• Clues: joint-line pain, painful click with deep flexion, stiffness after sitting, possible effusion (swelling). Root tears can cause sudden pain with a deep squat and feel like “something gave way,” sometimes with catching. 

• Typical story: increased training volume, lots of stairs, cycling seat too low, or recent growth spurt.
• Clues: anteromedial ache, movie-goer stiffness, a thin band-like snap with knee extension, pain with plica stutter test (patella “jumps” between 30-60^\circ flexion), and tenderness just medial to the patella. 

• Typical story: hill running, new lunges/squats, rapid mileage jump, valgus knee mechanics.
• Clues: point tenderness below joint line, worse with stairs or getting up from a chair. Clicking here is often a soft-tissue rub, not intra-articular catching. 

• Typical story: repetitive flexion-extension (rowing, deep squats), mild instability.
• Clues: palpable tendon snap along the inner back of the knee; often non-painful or mildly sore.

• Typical story: old injury, sudden true locking or repeated catching episodes.
• Clues: episodes where the knee won’t move until you jiggle it; may have swelling. Needs imaging and orthopedic review.

History patterns

• Plica: pain increases with prolonged sitting, stairs, squats, cycling at low seat height; “band” catching medially.
• Meniscus: pain with twist/pivot, deep knee bend, getting up from squats; morning stiffness that eases with movement.

At-home hints

• Plica: slow knee extension from a partial squat may recreate a faint rub/stutter near the kneecap’s inner edge.
• Meniscus: a sharp jab when twisting on a planted foot or deep squatting is more suspicious.

In-clinic tests (what to expect)

• Meniscus: McMurray (click with tibial rotation), Thessaly (pain/instability while turning on a bent knee), joint-line tenderness, Ege (deep squat with feet turned out/in). 10
• Plica: Plica stutter (patella “jumps” during extension), tenderness of the medial plica band, symptoms reproduced with resisted knee extension.

Imaging

• MRI detects meniscal tears, root tears, and loose bodies; it can show a thickened plica but clinical correlation is key.
• Ultrasound is useful for dynamic snapping tendons and pes anserine bursitis; it can guide injections.

• True locking (knee stuck and won’t move)
• Rapid or recurrent swelling, especially after a twist injury
• Give-way episodes or new instability
• Fever, warmth, severe night pain (possible infection/inflammatory cause)
• History of cancer with new unexplained knee pain
• Persistent catching beyond 2-3 weeks of smart self-care

Most patients improve with activity modifications and targeted physiotherapy. The art is choosing the right mix for the likely cause.

Activity modifications (week 1-3)

• Temporarily reduce deep knee flexion (full squats, deep lunges), pivoting sports, and high-impact jumps.
• Swap to flat-ground cycling (seat slightly higher to reduce plica rub), elliptical, or pool running.
• Use relative rest (not bed rest): keep moving within a 3-4/10 pain ceiling during and after activity.

Home pain control

• Ice or cool packs 10-15 minutes after activity.
• Short course of NSAIDs if appropriate (or topical NSAIDs).
• Consider a neoprene sleeve for warmth/proprioception; it won’t “hold cartilage in place,” but it can make movement feel smoother.

Targeted physiotherapy (the “engine” of recovery)

1. Meniscus-friendly strength (2-3×/week):
   • Quadriceps sets → wall sits (pain-limited) → leg press (shallow range initially)
   • Hamstring bridges (double → single-leg), Romanian deadlift pattern with light load (hinge, not deep knee bend)
   • Hip abductors/external rotators: side-lying leg raises, monster walks, clamshells
   • Calf raises (support medial joint mechanics)

   Progress range of motion and load only if no increase in next-day pain/swelling.

2. For suspected plica:
   • Prioritize quad endurance in mid-range (short-arc quads, terminal knee extension with bands)
   • Bike seat slightly high, avoid low saddle grinds
   • Patellar taping (medial plica offload) as guided by a physio
3. For pes anserine pain:
   • Gentle hamstring stretching (no ballistic), adductor mobility, soft-tissue work
   • Eccentric hamstring work (Nordic regressions or slider curls) when symptoms settle
   • Address valgus collapse with hip strengthening and cueing

• Pes anserine bursitis: Ultrasound-guided corticosteroid injection can calm a stubborn bursa when rehab alone lags.
• Plica syndrome: If 6-8 weeks of solid rehab fails, arthroscopic plica resection can help carefully selected patients. 7
• Meniscal tears:
  • Young/traumatic tears or root tears → often repair rather than trim (better long-term joint preservation). 
  • Degenerative, stable tears without mechanical symptoms → physiotherapy first frequently matches surgery in pain/function at 6-12 months. 
• True mechanical locking or displaced flap/loose body → arthroscopy is reasonable.

Note: PRP or hyaluronic acid are not first-line for clicking/catching; potential roles are condition-specific and evidence is mixed. Use case-by-case specialist guidance.

• Uncomplicated plica or pes anserine: noticeable improvement in 2-4 weeks; near-full activity by 6-8 weeks with consistent rehab.
• Meniscal rehab (non-operative): meaningful progress by 6-8 weeks; steady gains to 12+ weeks.
• Meniscal repair: brace/protected weight-bearing early; running often 3-4 months, pivot sports 4-6+ months as cleared.
• Partial meniscectomy (trim): quicker return (3-6 weeks for light sport), but weigh long-term cartilage health when choosing surgery.

You’re likely ready if you can:

• Perform single-leg squat to \sim 60-70^\circ without valgus collapse or pain
• Do 10-15 single-leg hops with symmetrical landings, no pain or swelling later that day or the next
• Jog 20-30 minutes on level ground pain-free
• Complete workout sessions with 0-2/10 discomfort that doesn’t spike afterward

• Two-week rule: if clicking/catching steadily improves with the above plan, continue. If it persists or worsens, book an evaluation.
• Location test: joint-line pain with twist → meniscus suspicion (clinic tests/MRI may be needed). Pain below joint line → likely pes anserine (treat as above first).
• Locking test: if the knee locks or you must “unlock” it frequently, seek care promptly.

I have medial knee clicking but no pain. Do I need an MRI?

Usually no—painless clicking can be benign. If it becomes painful, starts catching/locking, or swelling appears, get evaluated.

How do I know it’s a meniscus tear and not plica?

Twist-related pain at the joint line, sharp twinges with deep bend, and swelling point to meniscus. A thin band-like rub near the inner kneecap with stairs/squats fits plica. A clinician can confirm with exam maneuvers and, if needed, imaging.

Can a meniscus tear heal without surgery?

Some stable or small degenerative tears improve with rehab. Traumatic tears in younger athletes and root tears more often need surgical repair.

Is pes anserine bursitis the same as a meniscus issue?

No. Pes anserine pain sits below the joint line and is a soft-tissue problem. It rarely causes true catching; it’s very responsive to load management and targeted strengthening.

What exercises should I avoid early on?

Deep squats, twisting under load, walking lunges with long strides, and low-seat heavy cycling if plica-type symptoms are present. Reintroduce gradually as symptoms settle.

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